Association of obesity and health related quality of life in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study

Novel Anthropometric Indices as Screening Tools for Obesity: A Study on Healthy Iranians

Background and Aims

Upper body fat distribution is more related to cardiometabolic diseases than central obesity. Neck circumference (NC) and neck-to-height ratio (NHtR) are two indicators of upper body obesity that are affordable, easy to obtain, highly reproducible, and more practical in the crowded health centers than the classic anthropometric indices.

Methods

18-65-year-old individuals with no past medical history were included. After obtaining written informed consent, they were screened for hypertension, high blood glucose, and other abnormal laboratory results. Data were analyzed using SPSS and Mann-Whitney U test, Chi square test, Spearman's correlation coefficient, and ROC curve.

Results

In our 2,812 participants, NC had the lowest area under the curve (AUC) in both male and female obese and overweight subjects. NHtR and hip circumference (HC) had the highest AUC in men and women with obesity, respectively. The highest sensitivity for overweight men and women belonged to waist circumference (WC) and waist-to-height ratio (WHtR), respectively, and for both males and females with obesity, NHtR had the highest sensitivity. The cutoff point of NHtR had the same value for males and females. HC and NHtR had the highest positive likelihood ratio (PLR) for obesity in men. In addition, HC and WC had the highest PLR for obesity in women.

Conclusion

In this study, we revealed that NC had the lowest and NHtR and HC had the highest predictive value for obesity. Furthermore, for both males and females with obesity, NHtR had the highest sensitivity. HC had the highest PLR for obesity in both genders. Our results warrant prospective studies to evaluate the role of NHtR and other novel anthropometric indices in the risk of cardiometabolic diseases.

Body size, form, composition, and a healthy lifestyle associates with health-related quality of life among Portuguese children

OBJECTIVES

This study aimed to describe the relationship between body size, form, and composition, and children's lifestyle on health-related quality of life (HRQoL).

METHODS

This cross-sectional study comprised 1333 children (9.05 ± 0.75 years; 683 females) living in mainland Portugal. Objective anthropometric measures were collected. Parents answered a standardized questionnaire related with children's lifestyle (e.g., sport participation, screen- and sleep-time) and family socioeconomic status (e.g., parental education). HRQoL was measured using the Portuguese version of the KIDSCREEN-27. Scores were categorized into low and high using a sex-specific normative cut-off from European children. A healthier score was created including positive scores for body weight, abdominal obesity, sport participation, sleep- and screen-time.

RESULTS

Body size, form and composition were correlated with children's physical wellbeing. However, sex differences were found in which parameters were associated with wellbeing. Among boys, the body mass index, waist circumference, waist-to-height ratio, subscapular and suprailiac skinfold were most correlated with wellbeing, while waist circumference and subscapular skinfold showed the strongest correlations for girls. Sleep duration and sport participation revealed a significant relationship with girls' HRQoL. A logistic regression analysis (adjusted for parental education) revealed that boys scoring 4 or 5 in the healthier index had an increased likelihood of high HRQoL level compared to those fulfilling none.

CONCLUSIONS

Future programs aimed at reducing obesity, particularly central obesity, and incorporating multiple health indicators and behaviors, such as sport participation and sleep duration may help improve children's health and wellbeing.

The promotion of healthy breakfast and snacks based on the social marketing model: a mixed-methods study

BACKGROUND

Skipping breakfast and replacing it with non-nutritious snacks are progressively increasing among adolescents. This study aimed to develop an educational intervention based on the Social Marketing Model and evaluate its effects on healthy breakfast and snack consumption among female adolescent students.

METHODS

This mixed-methods study was conducted in 2016-2019 in two phases. In the first phase, a qualitative study was conducted through directed content analysis in guidance schools in Khorramabad, Isfahan, and Tehran, Iran, to explore factors affecting breakfast consumption. The results of this phase were set in the benchmarks of the Social Marketing Model. In the second phase, a randomized controlled trial was conducted based on the benchmarks of the Social Marketing Model on 94 students randomly recruited from guidance schools in Khorramabad, Iran.

RESULTS

The findings of the qualitative phase were categorized into the benchmarks of the Social Marketing Model, namely the social marketing mix, the intended behavior, internal and external competing factors for behavior modification, theoretical concepts related to the behavior, and the role of supporters. In the quantitative phase, the univariate analysis showed significant between-group differences concerning the product, price, promotion, and behavior (p < 0.05).

CONCLUSION

Healthy breakfast and snack consumption can be promoted through making acceptable the tastes, costs, preparations, and consumption places of breakfast and snack.

TRIAL REGISTRATION

The trial was registered in the Iranian Registry of Clinical Trials (code: IRCT20170201032347N1 ). The trial was registered in 11/07/2018 and is accessible on the Iranian Clinical Trial Registration website.

Overweight, obesity, weight-related behaviors, and health-related quality of life among high-school students in Turkey

PURPOSE

The purpose of this study was to assess the prevalence of overweight and obesity, and associated socio-demographic and lifestyle behaviors among a sample of high-school students in Turkey. This study also examined the effect of overweight and obesity on health-related quality of life in students.

METHODS

A cross-sectional survey of 1216 adolescents aged 14-18 years old was conducted from 2018 to 2019 in Turkey, using questionnaire forms and anthropometric measurements. Classification of BMI was based on the WHO reference weight categories. Factors linked to adolescent obesity were identified using the binary logistic regression model and the degree of association was revealed by determining the odds ratio, at a confidence interval (CI) of 95%.

RESULTS

The prevalence of overweight was 26.1%, while that of obese students was 12.8%. Factors associated with being obese included being in the 14-15 age group, being male, having dysfunctional family relationships, spending more than 3 h/day on screen time, and performing physical activity (≥ 60 min) two times or less per week. Obese adolescents reported significantly lower scores in physical and mental health.

CONCLUSIONS

In this study, more than one-third of the students were either overweight or obese. Obesity was associated with screen time, physical activity, and family relationship. Obesity in children had a negative impact on their quality of life. Therefore, increasing physical activity, lowering screen time, and having a healthy parent-adolescent relationship could contribute to reducing the prevalence of obesity in overweight/obese students.

LEVEL OF EVIDENCE

Level V, descriptive (cross-sectional) study.

Socioeconomic inequalities in children's health-related quality of life according to weight status

OBJECTIVES

This study explores the association between socioeconomic position (SEP) and health-related quality of life (HRQoL) among Portuguese children according to their weight status.

METHODS

A total of 1215 primary school-aged children (mean age 8.78 years) from three Portuguese districts (Lisbon, Porto, Coimbra) were assessed during 2016/2017. Father and mother's education (low, medium, high) and work status (employed, unemployed/retired) were used as SEP indicators. Self-reported HRQoL was assessed with the KIDSCREEN-27. Height and weight were objectively measured and body mass index categorized in normal, overweight or obese. Age, sex, and district-adjusted linear regression models were fitted to estimate associations between SEP indicators and HRQoL dimensions, according to weight status.

RESULTS

We found that 24.9% of children were categorized as having overweight/obesity. The mean scores of the Physical Well-Being, and School Environment dimensions of HRQoL were lower among children classified with overweight/obesity compared to children with normal weight (57.21 vs 54.11, P < .001 and 57.85 vs 56.04, P = .010, respectively). Father's education was significantly associated with all HRQoL dimensions in children with a normal weight, but the same was not observed among children presenting overweight/obesity. An increase in the level of maternal education was also significantly associated with all HRQoL dimensions among children classified with a normal weight, and only for the School Environment dimension among children classified with overweight/obesity.

CONCLUSIONS

These results suggest the presence of socioeconomic inequalities in self-reported HRQoL from early age, particularly among children with normal weight.

Effectiveness of cognitive-behavioral therapy on nutrition improvement and weight of overweight and obese adolescents: A randomized controlled trial

AIM

To assess the effectiveness of a cognitive-behavioral treatment (CBT) program on weight reduction among Iranian adolescents who are overweight.

METHODS

Using a randomized controlled trial design, 55 adolescents who were overweight (mean [SD] age = 14.64 [1.69] years; zBMI = 2.18 [0.65]) were recruited in the CBT program and 55 in the treatment as usual (TAU; mean age = 14.88 [1.50]; zBMI = 2.09 [0.57]) group. All the participants completed several questionnaires (Child Dietary Self-Efficacy Scale; Weight Efficacy Lifestyle questionnaire; Physical Exercise Self-Efficacy Scale; Pediatric Quality of Life Inventory; and self-reported physical activity and diet) and had their anthropometrics measured (height, weight, waist and hip circumferences, and body fat).

RESULTS

The CBT group consumed significantly more fruits and juice, vegetables, and dairy in the 6-month follow-up as compared with the TAU group (p-values <0.001). The CBT group consumed significantly less sweet snacks, salty snacks, sweet drinks, sausages/processed meat, and oils in the six-month follow-up compared with the TAU group (p-values<0.001). Additionally, the waist circumference, BMI, waist-hip ratio, and fat mass were significantly decreased in the CBT group in the six-month follow-up compared with the TAU group (p-values<0.005). The CBT group significantly improved their psychosocial health, physical activity, and health-related quality of life (p-values<0.001).

CONCLUSION

The CBT program showed its effectiveness in reducing weight among Iranian adolescents who were overweight. Healthcare providers may want to adopt this program to treat excess weight problems among adolescents.

Comparison of health-related quality of life (HRQoL) among healthy, obese and chronically ill Iranian children

Background

Health-related quality of life (HRQoL) has frequently been compared between both healthy and obese children and healthy and chronically ill children; however, there is glaring lack of evidence regarding comparison of HRQoL in obese children with their counterparts with chronic diseases. Therefore, this study aimed to compare HRQoL among healthy, obese and chronically ill children.

Methods

This cross sectional study was conducted among 802 children (8–12 years) who were recruited via convenience sampling method. Participants were 98 healthy, 102 obese and 602 chronically ill children with six groups of chronic conditions including different types of cancer, rheumatoid arthritis, chronic gastrointestinal, kidney, neurologic and respiratory diseases. HRQoL was assessed using the Iranian version of the PedsQL questionnaire and both reports including child self-report and parent proxy-report were obtained. To compare subscales and total scores of HRQoL among healthy, obese and six groups of chronically ill children, the general linear model was used.

Results

Mean self-reported HRQoL total scores were 73.7 ± 13.3 and 74.6 ± 11.8 in girls and boys respectively; based on the parents’ reports, mean HRQoL total scores were 71.6 ± 15.4 and 71.4 ± 13.0 in girls and boys respectively. From the prespectives of both children and parents, HRQoL total score was significantly lower in obese girls compared to both healthy girls and girls with chronic gastrointestinal, kidney, neurologic and respiratory diseases. Considering both children’s and parents’ reports, HRQoL total score was significantly lower in obese boys compared to both healthy boys and boys with chronic respiratory diseases. In terms of subscales of HRQoL, the impairment of HRQoL in obese children, compared to their counterparts with other chronic diseases, was more common in social functioning and physical functioning subscales, specifically in girls.

Conclusion

Obese children reported poorer HRQoL compared to their healthy counterparts, as well as their counterparts with chronic diseases. Current findings emphasize the important impact of childhood obesity on the perceived health of these children, particularly in the social dimension, underscoring thereby the designing, planning and implementation of health promotion programs for prevention and treatment of childhood obesity.

A hierarchical Bayesian tri-variate analysis on factors associated with anthropometric measures in a large sample of children and adolescents: the CASPIAN-IV study

BACKGROUND

This study aimed to assess determinants of anthropometric measures in a nationally representative sample of Iranian children and adolescents.

METHODS

This nationwide study was conducted among 13,280 students, aged 6-18 years, who were randomly selected from 30 provinces in Iran. Anthropometric measures were determined by calibrated instruments. Demographic and socio-economic (SES) variables, lifestyle behaviors, family history of chronic disease and prenatal factors were studied, as well. A hierarchical Bayesian tri-variate analysis was used to assess the factors associated with obesity measures of the body mass index (BMI), waist-to-height ratio (WHtR) and wrist circumference (WrC).

RESULTS

The results showed that the BMI was associated with SES score, family history of obesity, family history of diabetes mellitus, physical inactivity, screen time, duration of sleep, breakfast consumption, birth weight, breastfeeding, junk food and place of residence (urban-rural). All these factors were also significantly associated with WrC except for consumption of junk food. Many of these factors had a partial but significant relationship with WHtR.

CONCLUSIONS

Various factors contribute to obesity. Preventive and educational programs on manageable factors such as increasing physical activity, eating breakfast and limiting TV or screen time could be helpful in controlling obesity in schoolchildren and reducing associated complications.

The relationship between body mass index (BMI) and quality of life in Iranian primary school students in Tehran, Iran

BACKGROUND

This study aimed to investigate the relationship between Body Mass Index (BMI) and quality of life in primary school students in Tehran.

METHOD

In this cross-sectional study 829 primary school children and their parents participated. Healthrelated quality of life (HROOL) was evaluated with the Persian version of Pediatric Quality of Life Inventory (PedsQL™4.0) questionnaire. According to objective measures of height and weight, children BMI computed, and adapted for age and gender. For data analysis we used Pearson correlation test, Independentsample t-test and ANOVA using SPSS version 18.

RESULTS

Mean of children self-reported HRQOL total score was 82.05 ± 12.04 and mean of parent proxyreported HRQOL total score was 81.66 ± 12.81. Based on HRQOL subscale scores, social functioning was the highest subscale score of HRQOL (84.67 ± 15.07) and the emotional subscale score was the lowest (77.79 ± 17.26). Lower HRQOL scores were significantly correlated with Higher BMI and normal weight children had significantly higher HRQOL total score than obese children (P < 0.05). The difference between normal weight and overweight children in HRQOL total scores were not significant. Same results were obtained from parent proxy-reports and a good harmony between children self-report and parent proxy-report of HRQOL was perceived.

CONCLUSION

This study showed that HRQOL of obese children were at the lower level in comparison to normal weight and overweight children. At further interventional studies these outcomes can be very important for improving quality of life in obese children.